Download Mental Illness Demographics

Co-Occurring Substance
Disorders and Mental Illness
among Inmates
Tawnya J. Meadows, Ph.D.
Kelly McKillip, B.A.
James R. Meadows, Ph.D.
Beth Ehrisman, B.A.
Preview
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Demographics/Statistics
Mental Illness
Substance Abuse
Questions
Demographics
 Over 2 million individuals are incarcerated
in jails and prisons
 4.5 million adult men and women are on
probation or parole
Mental Illness Demographics
 6.4% of males and 12.2% of females
entering jail have severe mental disorder
(schizophrenia, mania and major
depressive disorder)
 57% have active mental disorder without
substance use
 Each arrest significantly increases risk of
MI (double)
Substance Use Demographics
 29.1% of men and 53.3% of female detainees had a current
substance use disorder
 Up to 83% were seriously involved with drugs or alcohol
 64% of jail inmates use drugs regularly with 47% use regularly
the month before arrest
 82% of state and 85% of federal inmates are convicted of
substance-related crimes, under influence at time of arrest,
committed crime to get drugs, regular use of alcohol or drugs
 Women entering jail are at least 9 times as likely to have a
substance use disorder than the general population
 More women than men are in jail for drug charges
 46% of jail inmates have driven while high; 48% while drunk
 17% have lost a job because of drugs; 11% because of alcohol
 Only 8% jail inmates receive any form of substance abuse
treatment
Dual Diagnosis / Co-Occurring
 72% rate of co-occurring substance use disorder
and severe mental disorder
 Females more likely than males to have dual
diagnosis
 Those with mental illness (MI) are 2 times more
likely to be arrested than those without MI
 No universal standards for dual diagnosis
 Dual diagnosis should be expectation, rather than
the exception
Demographics
Table 1
Demographics by Risk Classification
(n= 311)
Gender*
Female
Male
Race/Ethnicity
Nonwhite White
High School (GED)
NO
YES
% (n) %
(n) % (n) %
(n) % (n) %
(n)
40.7 (44) 31.5 (64) 32.7 (82) 42.2 (25) 39.6 (57) 30.5 (51)
Dual Risk
Mental Disorder
Risk Only
Substance Abuse
Risk Only
23.1 (25) 15.8 (32) 17.9 (45) 20.3 (12) 18.1 (26) 18.6 (31)
13.0 (14) 19.2 (39) 16.3 (41) 20.3 (12) 14.6 (21) 19.2 (32)
23.1 (25) 33.5 (68) 33.1 (83) 16.9 (10) 27.8 (40) 31.7 (53)
No Risk
*p<.05
Which comes first?
 Chicken or the egg?
Co-Occurring Disorders
 Depressive Disorders
 Schizophrenia
 Personality Disorders
Depressive Disorders
Major Depressive Disorder
Dysthymic Disorder
Depressive Disorder, NOS
Bipolar Disorder
Cyclothymic Disorder
Bipolar Disorder, NOS
Mood Disorder due to a General Medical
Condition
 Substance-Induced Mood Disorder
 Mood Disorder, NOS
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Schizophrenia Criteria
 Types: Paranoid, Disorganized, Catatonic,
Residual, Undifferentiated
 Inappropriate affect
 Poor insight regarding psychotic illness
 Anhedonia (loss of interest or pleasure)
 May have disturbances in sleep pattern
 May refuse food due to delusional beliefs
 Abnormalities in psychomotor activity (pacing,
rocking or apathetic immobility)
 Difficulty with concentration, attention, and
memory
Schizophrenia Statistics
 Adults= 0.5% to 1.5% of population
 Elevated risk reported among urban-born
compared with rural-born individuals
 Declining incidence for later-born birth
cohorts
Personality Disorder
Types: Odd/Eccentric
 Paranoid: pattern of distrust and
suspiciousness, such that others’ motives
are interpreted as malevolent
 Schizoid: pattern of detachment from
social relationships and restricted range of
emotional expression
 Schizotypal: pattern of acute discomfort in
close relationships, cognitive or perceptual
distortions and eccentricities of behavior
Personality Disorder
Types: Dramatic/Emotional/Erratic
 Antisocial: pattern of disregard for, and
violation of, the rights of others
 Borderline: pattern of instability in
interpersonal relationships, self-image, and
affects and marked impulsivity
 Histrionic: pattern of excessive
emotionality and attention seeking
 Narcissistic: pattern of grandiosity, need
for admiration, and lack of empathy
Personality Disorder
Types: Anxious/Fearful
 Avoidant: pattern of social inhibition,
feelings of inadequacy, and hypersensitivity
to negative evaluation
 Dependent: pattern of submissive and
clinging behavior related to an excessive
need to be taken care of
 Obsessive-Compulsive: pattern of
preoccupation with orderliness,
perfectionism and control
Vulnerability to Drug and
Alcohol Abuse
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Biological
Personal characteristics
Family situation
Social and community factors
 The more factors, increased likelihood
Alcohol
How Alcohol is Used
 Drink in liquid form
 May be snorted
Effects of Alcohol
 Feeling of well-being and stimulation
Psychiatric Effects of Alcohol
 Worsens depressive illness
 Increases suicide risk
 Accentuates sleep problem-users wake in
middle of night as blood alcohol level falls
 May cause personality changes
 Loss of recent memory
 Dis-inhibiting effects may lead to serious
violence
More Psychiatric Effects of
Alcohol
 May induce psychosis similar to schizophrenia
with ideas of persecution and “voices”
 Sudden withdrawal for someone who has
developed addiction can produce alarming
symptoms
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Autonomic hyperactivity (sweating or pulse increases)
Hand tremor
Nausea or vomiting
Grand mal seizures
Insomnia
Anxiety
Other considerations
 Antabuse (antagonist)
 125,000 alcohol-related deaths each year in
the US
 Many Asians lack an enzyme needed to
metabolize alcohol and have immediate
aversive effects
 Caffeine may exacerbate alcohol effects
Methamphetamine
How Meth is used
 Injected or smoked- immediate and intense
rush
 Snorted or ingested orally- not as intense
and takes more time to effect
Effects of Meth
 Rapid heart rate, increased blood pressure,
damage to small blood vessels in the brain. . .
Stroke
 Inflammation of heart lining
 Overdoses may cause hyperthermia, convulsions,
and death
 Chronic users who inject- HIV, Hepatitis B and
C, collapsed veins, heart lining infections
Psychiatric Effects of Meth
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Violent behavior
Paranoia
Anxiety
Confusion
Insomnia
** Effects may persist for months and years
after individual has stopped using the drug
PCP
How PCP is used
 Snort powder, swallow tablets or smoke by
applying it to a leafy substance, such as
marijuana, mint, parsley or oregano
 Increasingly it is used by dipping
marijuana or tobacco cigarettes into liquid
PCP and smoking
Effects of PCP
 Affects growth hormones and can impede
learning process
 Agitation, excitement, delirium, hostility,
and disorganization of perceptions
 May cause seizures, coma, and death
 Effects persist up to a year after stopping
use
Psychiatric Effects of PCP
 Psychological dependence, craving, and
compulsive behavior
 Low doses- combativeness and catatonia
 Long-term use can lead to memory loss,
difficulty with speech or thought,
schizophrenia, depression, and weight loss
 Effects may resemble symptoms associated
with schizophrenia, including delusions
and paranoia
Ecstasy
How Ecstasy is used
 Swallowed as a tablet
 Crush tablet and snort
Effects of Ecstasy
 Feelings of euphoria
 Heightened perception of surroundings
Psychiatric Effects of Ecstasy
 Degree of anxiety, panic, confusion, and
insomnia
 Rarely, users may experience a paranoid
psychosis with hallucinations like that
found with other amphetamines
 Some deaths reported, seizures, and
prolonged comas
Other considerations of Ecstasy
 Most users experience no ill effects and
deem it safe
 Produced in illicit drug factories and labs,
so composition varies and may contain
toxic additives or more potent varieties
 Long-term effects unknown, but lab animal
experiments suggest it is highly toxic if
taken over long periods
Marijuana/Cannabis
How Marijuana is used
 Smoke
 Chew on seeds
Effects of Marijuana
 Talkativeness, relaxation, cheerfulness
 Enhanced appreciation of sound and color
 Reduction in ability to do complicated
tasks
 Frequent chest colds
 Increase heart rate
Psychiatric Effects of Marijuana
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May affect short-term memory
Difficulty in concentration
Heavy use- psychosis
Anxiety
Panic attacks
Schizophrenia
Feels like loss of control
Worsens bipolar symptoms
High doses- Hallucinations, Image distortion,
loss of personal identity
Other considerations of
Marijuana
 1960 average joint contained 10 mg Thc
 2005 average joint contains 150+ mg
 48% of all high school seniors have used at
least once
 37% of all US citizens 12 years and older
have used marijuana
Cocaine/Crack
How Cocaine is used
 Snorted
 Smoked
 Injected intravenously
Effects of Cocaine
 Feelings of euphoria, exhilaration, and
confidence
 Accelerated heart rate
 Increase in body temperature
 A burst of energy
 Dilated pupils
 Loss of appetite
 The urge to have sex
Psychiatric Effects of Cocaine
 Prolonged use can lead to severe anxiety
and insomnia
 Cocaine psychosis may develop with ideas
of persecution and various hallucinatory
experiences
 May cause anxiety or panic and people
suffering from anxiety states should be
especially careful
Other considerations of Cocaine
 Rapid acting and cause dependence and
compulsive use in some users
 Unpleasant “rebound” symptoms occur as drug
wears off
 Effects generally clear up once the use of cocaine
stops
 Nationwide, 38% of detainees test positive
 Clonidine may ease withdrawal
 Bromocriptine may reduce craving
 Every 1 dollar spent on cocaine treatment in
prison saves $7.48 in societal benefits
Prescription Drugs
 Ritalin (stimulant)- Kibbles and bits, Kiddy
cocaine, pineapple, skippy, smarties,
Vitamin R, west coast
 Ritalin and Talwin (pain killer)- crackers,
ones and ones, rits and ts, set, ts and rits, ts
and rs
How Prescription Drugs are
Used
 Ritalin- swallow, crush to snort, dissolve in
water (not all) and inject
Effects of Prescription Drugs
 Ritalin- appetite suppression, wakefulness,
euphoria, increased focus and attention,
cardivascular complications, if inject- risk
blocking blood vessels, HIV, Hepatitis B
and C
Psychiatric Effects of
Prescription Drugs
 Ritalin- psychotic episodes, severe
psychological addiction
Relapse
 Statistics
 29-42% of individuals drop out of treatment
 Relapse rate 35-90%
 67% relapse within 4 months of residential treatment
 Why
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False sense of control over addiction
Fail to change prompting behaviors or triggers
Deny existence of addiction
Lack of coping skills
Self-efficacy problems
Positive effects of substance abuse
Relapse Prevention
 Removal of stimuli
 Accurately assess for co-occurring
disorders
 Treatment of co-occurring mental illness
Reciprocal Relapse
 One addiction precipitates relapse of
another addiction
 Example:
 May be sober, but continue to engage in
other addictive behaviors
Addictions Intervention Education
 Physiological effects of alcohol and other drugs,
interactions, and the effects on behavior and
driving
 Possible psychological consequences
 Blood Alcohol Concentration importance,
legalities, physical effects
 Resources for treatment and support
 Alternative activities to drug and alcohol use
 Understanding costs of use
Coping Skills Training
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Decision making
Relaxation techniques
Exercise!!!
Good nutrition
Replacement behaviors
Setting goals
Making plans to execute
goals
Establishing social network
Legal social activities
Problem solving techniques
Awareness of community
resources
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Job/career skills and training
Behavioral self-control
Avoiding high risk situations
Social skills training
STD/HIV training
Pacing/teaching moderation
drinking skills and strategies
Tapes of them
high/inebriated
Noncatastrophizing thoughts
Identification of stress
Assertiveness training
Questions